Background: Postpartum hemorrhage (PPH) is major cause of morbidity and mortality globally. Although the majority of PPH could be avoided through the use of pharmacologic prevention during the third stage of labor, the maternal mortality rate from PPH is unchanged and the blood transfusion rate is increasing. In rural hospital or primary care unit, most health care workers are general practitioners and intern doctors, they are inexperienced in managing PPH case and lack of medication, blood component, medical instrument, and surgical team. Most deaths are from delay and incorrect treatment in the primary hospital. Thus, early detection of PPH could decrease maternal morbidity and mortality.
Objective: To develop a risk score based on maternal clinical characteristics and medical history for prediction of postpartum
hemorrhage (PPH) in normal labor in the antepartum period. The present study was a part of risk management developing
system that conform to service plan of the Public Health Ministry.
Material and Method: A retrospective cohort study reviewed the medical charts for normal labor between September 1, 2012
and October 31, 2015, at Chonburi Hospital, Thailand. Risk factors were identified and analyzed by multivariable logistic
regression. Risk score was conducted according to adjusted odds ratio of each significant variable in regression model.
Results: Among 650 women, advanced maternal age, body mass index before pregnancy, pregnancy induced hypertension
and diabetes mellitus types 2 were significantly associated with PPH in normal labor. These factors were incorporated into a risk score that could be predicted PPH in normal labor with sensitivity 81.3% and specificity 50.8% at optimal cut-off score equal or greater than 4.
Conclusion: Applying developed PPH risk score is a practical way to identify patients who are at high-risk for developing PPH for an early detection, treatment, and transfer.

Keywords: Postpartum hemorrhage, PPH, Normal labor, Normal delivery, Risk score, Prediction